Tag Archives: PAVM

PUBLISHED: Pulmonary AVM Embolization

Pulmonary AVM Embolization
Jelena Ivanis1; Andrew Ding1; Dennis Barbon1; Fabian Laage-Gaupp, MD2; Jeffrey Pollak, MD2
1Frank H. Netter, MD School of Medicine at Quinnipiac University
2Yale School of Medicine

Pulmonary arteriovenous malformations (PAVMs) are rare fistulous connections between pulmonary arteries and veins that, as in this case, are commonly associated with hereditary hemorrhagic telangiectasia (HHT). Embolotherapy, the mainstay of treatment for PAVMs, is a procedure in which the feeding arteries of a malformation are endovascularly occluded under fluoroscopic guidance. Effective and well-tolerated, embolotherapy has been shown to decrease right-to-left shunting following treatment and decrease risks of paradoxical embolization and lung hemorrhage and to improve pulmonary gas exchange and lung function. Patients are selected for treatment according to clinical suspicion for the presence of a PAVM and feeding artery diameter. The occlusion of PAVMs with arteries that exceed 2–3 mm in diameter is recommended.

Diagnostic contrast-enhanced pulmonary angiography is performed via injection of contrast through a percutaneous catheter to characterize and confirm PAVMs suitable for embolization. Lesions are then treated by catheter-directed placement of embolic material— vascular plugs in this case—into the feeding artery, terminating blood flow to the area of the lesion. Although multiple PAVMs may be embolized during a single session, in patients with HHT, who may present with large numbers of PAVMs, treatment is limited by maximum contrast dosage, and additional sessions may be performed if PAVMs remain perfused.

PREPRINT RELEASE: Pulmonary AVM Embolization

Pulmonary AVM Embolization
Yale New Haven Hospital

Jeffrey Pollak, MD
Robert I. White, Jr. Professor of Radiology and Biomedical Imaging
Yale School of Medicine

Fabian Laage-Gaupp, MD
Yale School of Medicine

Dennis Barbon; Andrew Ding; Jelena Ivanis;
Frank H. Netter, MD School of Medicine at Quinnipiac University

A 14-year-old female with occasional nosebleeds and a PMH significant for HHT (diagnosed clinically and confirmed via genetic testing) underwent chest CT, which found multiple PAVMs. Here, Dr. Jeffrey Pollak performs endovascular embolization  of these PAVMs in our first interventional radiology case.